An indictment of federal health policy-making (under successive governments and health ministers) has just been published in this article tracing the history of bowel cancer screening in Australia.
Amongst other things, the paper reveals apparent communication breakdowns between the Department of Health and Ageing and the Department of Finance and Administration about the costing of a bowel cancer screening program. As a result, an appropriate allocation has never been made to enable proper implementation of the program.
There have been many other glitches and missed opportunities. As the University of Sydney researchers note in the Medical Journal of Australia: “Political, financial and institutional constraints combined to shape and limit the National Bowel Cancer Screening Program.”
The paper’s lead author, Kathy Flitcroft, Research Fellow with the Sydney School of Public Health’s Screening Test and Evaluation Program, has provided this analysis for Croakey readers.
“Cancer accounted for 29 per cent of all deaths in Australia in 2007. The latest report by the Australian Institute of Health and Welfare has revealed a projected 10 per cent rise over just four years in the number of new cases of cancer, and, according to Health Minister Nicola Roxon, cancer is placing “an intolerable burden on the community.”
The main reason for this projected rise in cancer incidence is the growth in population of those aged 60 years and over, the same age group most likely to develop bowel cancer. An effective bowel cancer screening program could help reverse this cancer rate increase.
Bowel cancer is a serious health problem in Australia. The latest figures reveal over 13000 new cases of bowel cancer per year, and over 4000 deaths from this very preventable disease. This makes bowel cancer the second most common cancer in Australia behind prostate cancer and the second biggest cause of cancer death in Australia behind lung cancer.
Bowel cancer is a natural candidate for a screening program as it is generally a slow-growing cancer that if found and treated in its early stages, has a high cure rate. A Faecal Occult Blood Test (FOBT) screening works by detecting the presence of blood in the large bowel, which is the major indicator of possible bowel cancer.
The National Health and Medical Research Council recommends biennial FOBT screening for those over 50 years of age, but the Australian government has not yet committed to implementing a full screening program.
Government justification for the limited roll-out of the bowel cancer screening program has been based on the need to ensure that there is adequate colonoscopy capacity to allow for prompt follow up of positive FOBTs. However, 450,000 colonoscopies are currently performed in Australia per year, mostly in the private sector, and many are being performed for lower-risk indications.
If colonoscopy capacity was prioritised for those with positive FOBTs, overall capacity would not be a problem. What may be needed however, is a way of ensuring that those without private health insurance are not excluded from receiving prompt follow up, and this could be achieved by a voucher system which entitled all individuals with positive FOBTs to have a colonoscopy in either the public or private system.
So, why should the Australian Government get on with it and properly fund a full bowel cancer screening program? The top five reasons are:
1) One quarter of bowel cancer deaths can be averted through implementation of an evidence-based bowel cancer screening program.
2) FOBT screening has been shown to actually reduce the incidence of bowel cancer, as removal of pre-cancerous polyps identified through colonoscopic follow up of positive FOBTs can prevent the disease from developing in the first place.
3) Early detection can save individuals and their families the pain, anxiety and suffering associated with late stage bowel cancer, including surgery, radiotherapy and chemotherapy. If cancer is detected before it has spread beyond the bowel, the chance of surviving for at least five years after diagnosis is 90%, and treatment options have much less severe impacts.
4) Bowel cancer screening is cost-effective. Several studies have consistently shown that bowel cancer screening is very good value for money, and has become even more so with the recent changes to chemotherapy agents used to treat late stage bowel cancer. The costs of treating late stage bowel cancer have risen dramatically, making early detection an even better economic deal.
5) Early detection can reduce the financial and administrative burden on health services by reducing the need for hospital stays, theatre time etc, a fact that should please the Australian government now that it is about to become a major hospital funder.
Australia offers comprehensive breast and cervical cancer screening programs that have contributed to reductions in deaths from these two diseases. Both of these programs are world-class, well-patronised, systematically monitored and have continuing funding.
Yet, bowel cancer kills more people each year than both these cancers combined, and it has not received the same ongoing commitment to funding. There have been no funds allocated to the bowel cancer screening program beyond June 2011.
A long-term commitment to rolling out a full bowel cancer screening program is urgently needed.”
You can do something positive by going to the Cancer Council Australia’s website (http://www.cancer.org.au/Home.htm) and joining their Get Behind Bowel Cancer Screening campaign, which aims to make bowel cancer screening policy an election priority.
• Meanwhile, the prostate cancer screening wars continue in the journal, with two urological surgeons rejecting claims that PSA testing has been a “public health disaster”.